The Shenanigans Involved With Scripting

[TheCommuter]

Nurses who have the misfortune of working at healthcare facilities that utilize Press Ganey patient satisfaction surveys are probably subjected to the practice of scripting.

For those who are unfamiliar with scripting, here's a brief rundown. Every nurse is supposed to recite the same pre-written scripted phrases to all of their patients with every interaction. The point is to reinforce the phrase 'very good care' in every patient's consciousness so that, upon each discharge, the facility will generate favorable patient satisfaction survey results. 'Very good care' translates into a score of five on the Press Ganey patient satisfaction survey.

A score of five is the highest rating each patient can bestow upon the facility on this particular survey. Likewise, 'very poor care' is the lowest rating any patient can give and would translate into a score of one on the survey.

Here are a few striking examples of the canned, scripted phrases some members of nursing staff are expected to recite to their patients. Be sure to take notice of the prominence of the key words 'very good':

1. "Is there anything I can do to make you more comfortable? I have the time!"
2. "We know you have many choices, so I'd like to thank you for choosing ABC Hospital, which is a very good facility."
3. "Your doctor is very good!"
4. "My goal is to exceed expectations and provide very good care!"
5. "Thank you for choosing ABC Hospital and I wish you well!"
6. "I want to assure you that we will do everything possible to exceed your expectations."
7. "Our goal is to provide you with very good care!"
8. "In 7 to 10 days, you will receive a survey from the hospital regarding your stay."
9. "Please let me know the moment we can do something better!"
10. "Staff recognizes this must be an inconvenience for you, but we strive to provide very good care!"
11. "You are making very good progress!"
12. "I am pulling the curtain to ensure your privacy."
13. "Our team wants to make your stay very good!"
14. "What? You asked for graham crackers 15 minutes ago and haven't received them? I'm sorry! That is far short of the very good service we aim to provide!"
15. "I sure want to ease your pain! I am going to get your pain medication!"

When dealing with scripting, I call shenanigans. I do not use scripting because the canned phrases sound phony and insult the intelligence of the patients. Moreover, repeated use of scripting insults the intelligence of nursing staff because management no longer believes in our human ability to establish connections with patients and families. Does administration truly believe that patients will automatically return surveys with ratings of 'very good care' if staff continually repeats the phrase?

I am wearily cognizant of all the new pressures surrounding the linking of Medicare reimbursement rates to scores received on patient satisfaction surveys, but uttering canned scripts over and over seems robotic and is devoid of any critical thought. Our encounters with patients should be honest and warm, not derived from phony scripts where the primary goal is reinforcement of a particular phrase.

[PMFB-RN, RN]

At my hospital they do enforce the scripting. The doctors script as well. We have gone to management and expressed our concern and they basically said "this is part of your job description, perhaps you should look for different employment if you find you can not accomplish this hospitals goals"

With 600 new grads a year and I am the primary bread winner in my family I play by their rules and realize that this is a trend like any other nursing trend. Some stay (computer charting) some go (wearing buttons on your scrubs that say "I have time for you")

This is SO sad! I understand the position you are in. What is sad about it is that this situation is EXACTLY why so much time and money were invested in creating the glut of nurses. The false "nursing shortage" propaganda was the main, but not only, tool used to amomplish it.

The availabliety of plenty of nursing jobs used to provide a buffer, or protection from managment abuses like you describe. Obviously something had to be done, hence the creation of a glut of nurses.

I feel like I am whitnessing the destruction of a fine and nobel profession.

[brandy1017, ASN, RN]

After much thought and reading, I decided to put the blame squarely on the shoulders of the federal government who enacted the ACA of 2010 with the Medicare reimbursement clause tying it to patient satisfaction. I really can no longer fault administration of hospitals for all this.

I was surveyed the other day for my own hospital, where I also happen to be employed. I just said "excellent" to everything, while thinking, "What do any of these questions have to do with whether or not I got better?" The only two remotely tied to outcome were pain control and communication.

The problem with pain control is you are dealing with some doctors that refuse to give narcotics, give tylenol when a person is writhing in pain and all the propaganda about drug addiction and discouraging doctors to give narcotics in the first place. Then you have other patients that can't get enough of their narcotics and yet they remain in pain. It seems impossible to get pain controlled for many patients. The patient suffers needlessly until the doctor finally relents and gives them the pain med they should have prescribed in the first place!

[martymoose, BSN, RN]

^^^

and of course they blame THE NURSE and take it out on them for not getting their pain meds........

[sandyfeet]

I don't use a script, but apparently I go over discharge instructions the same way each time! I had a fast-track patient in the ED I was discharging and as soon as I walked into the room we both paused and looked at each other like we recognized each other. About halfway through his paperwork he said "I remember you! You were my nurse when I had back pain last week! The way you go over paperwork reminded me!".

[TheCommuter, BSN, RN]

I found another older discussion on scripting from six years ago:

https://allnurses.com/nurse-colleague-patient/you-getting-very-283704.html

According to the original poster, management was also expecting staff at her particular facility to recite the "very good care" canned phrases.

[2015]

Every time I read one of these threads about scripting I am so dang grateful I am not in bedside nursing anymore. I couldn't force myself to say thank you for allowing me to care for you or so and so is an excellent nurse and has yada yada degrees and experience. I wouldn't say those things because I was trained in an era when doing all you could with everything available to you was the norm and it wasn't required to tell people that you did your job because it wasn't a popularity contest. It was about getting the care one needs to recover and return to life outside the hospital. It was about saving lives and functionality and working as a team and not a bunch of logo/catchphrase/marketing hook spewing folks. It was about understanding that being admitted to the hospital was focused on health and not fluff and nonsense.

I challenge all those administrative people who say the patient has a choice of which hospital they choose so we must be more appealing. I don't know about anyone else but I have to go to whichever hospital is in my insurance network and it will be the one closest to me. Giving me cookies, and bugging me every hour by mouthing meaningless phrases does not make for very good care IMO. I do feel for those nurses who must do this but I wish that some of you would help start a mini revolution among the patients and suggest that if the patients find scripting insincere and irritating that they mention that on the surveys. The practice is degrading to both the doers and the receivers. We should focus on the job at hand and clear transparent meaningful communication and not fill our time with meaningless drivel.

OK off soapbox now.

You are not even allowed to tell your patient that you were busy and that's why you are letting to bring the pain meds. You are admitting a very sick pt who needs all your attention so that the patient doesn't go downhill right at med rounds and when your 6th patient demands to know why you are late bringing his/her meds, you can't say you got caught up. Patients are led to believe that we have time and only have one pt on our assignment. The revolution should start there. It's almost a crime to tell a pt we are short staffed.

[2015]

Sorry about the above typos..won't let me edit.

[ohiobobcat]

The only time I use scripting is when I have a spare moment and can help out a co-worker. After checking to make sure management is lurking around, I've been known to say: "Fellow-co-worker, do you need me to do anything for you right now, because I have the time..." with a cheesy grin and two thumbs up.

I guess I understand WHY they want us to script. I just can't do it and feel natural about it.

[mclennan, BSN, RN]

Our managers went through some sort of required training last year and now when we ask a question they sarcastically say "how may I support you?" Much snickering and giggles ensue.

[blackvans1234]

What if the patient no speak da english?

Hola!

[blackvans1234]

I poke fun at our ''theraputic communication'' we learned in school in a similar way.

I start theraputically interrogating my friends.

Classmate is mad over something

"It seems like you're upset right now"

"Hey Blackvans1234 do you know when the paper is due?"

- "It's due tuesday. How does that make you feel?"

"I'm so tired from getting up for 7am clinicals"

- "Tell me more about that..." "How does it make you feel to get up for 7Am clinicals?"

[Bortaz, MSN, RN]

I script at work.

"Aww, did someone poop in your diaper?"

"No one likes a crybaby!"

"Where is your mama?"

"If you don't learn to suck a bottle, you're getting an OGT!"

"Would you like to use my phone to call the complaint department?"